Survey: Many Medicare beneficiaries fear receiving a surprise medical bill
FierceHealthIT
FEBRUARY 18, 2020
A majority of Medicare beneficiaries are worried about getting a surprise medical bill as Congress ponders how to handle the issue.
Chicago Social Worker Indicted for Telehealth Medical Billing Fraud
Telebehavioral Health Institute
JUNE 21, 2023
million for medical billing fraud from Medicare. The indictment alleges that the couple conspired with a social worker to submit false claims to Medicare, falsely stating that residents had received individual psychotherapy sessions lasting one hour. Medicare fraud, in particular, increases healthcare costs for everyone.
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Seniors on Medicare Advantage less likely to have issues paying medical bills: CDC study
FierceHealthIT
FEBRUARY 13, 2020
A new CDC study found significant gaps between Medicare and MA beneficiaries in having issues paying medical bills.
Medical Billing 
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Chicago Social Worker Indicted for Telehealth Medical Billing Fraud
Telebehavioral Health Institute
JUNE 21, 2023
million for medical billing fraud from Medicare. The indictment alleges that the couple conspired with a social worker to submit false claims to Medicare, falsely stating that residents had received individual psychotherapy sessions lasting one hour. Medicare fraud, in particular, increases healthcare costs for everyone.
Fixing Medicare Advantage Payments
Healthcare IT Today
FEBRUARY 22, 2023
There’s widespread consensus that payments to Medicare Advantage Organizations (MAOs) are a mess. These programs, which care for more than 30 million of the nearly 64 million Medicare enrollees , operate on the cutting edge of health care and suffer serious problems in data collection and billing.
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111 Bonus Features – September 24, 2023 – 72 percent of patients say affordability is the biggest challenge for paying medical bills
Healthcare IT Today
SEPTEMBER 24, 2023
Medicare Advantage costs are 12% lower than similar beneficiaries covered under fee-for-service Medicare, according to research from Inovalon and Harvard Medical School. Nearly three in four (72%) patients say affordability is the biggest challenge to paying larger healthcare bills , according to a survey from Cedar.
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Medical Debt, Aflac on Eroding Health Benefits, the CBO’s Uninsured Forecast & Who Pays for Rising Health Care Prices: A Health Consumer Financial Update
Health Populi
JUNE 24, 2024
He called out that, “In recent years, however, medical bills became the most common collection item on credit reports. Looking forward even further out a decade to 2034, the U.S. This has been coined as a kind of “unwinding” of Medicaid’s continuous eligibility provisions.
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Patients Growing Health Consumer Muscles Expect Digital Services
Health Populi
OCTOBER 15, 2019
These study respondents had also visited a doctor or hospital and paid a medical bill in the past year. One-third of these patients had a health care bill go to collections in the past year, according to Cedar’s 2019 U.S. 50% want clearer, easier-to-understand medical bills.
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The Health Care Costs for Someone Retiring in 2024 in the U.S. Will Reach $165,000 – Fidelity’s 23rd Annual Update
Health Populi
AUGUST 12, 2024
Note a couple of key assumptions: again that there are no long-term care expenses in this $165,000 — and that this calculation assumes the retiree would enroll in Traditional Medicare (not Medicare Advantage). As we continue to educate our patients, our families, and indeed ourselves (if you live in the U.S.),
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How to Discover Better Insurance Coverage, Together
Healthcare IT Today
FEBRUARY 23, 2023
Streamline the billing process The right RCM partner will help providers optimize revenue by creating faster, easier processes to identify insurance coverage. As Medicare Beneficiary Identifiers (MBIs) only relate to Medicare coverage, providers need tools that will go beyond MBIs and caps from payer searches.
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From Evolution to Innovation, from Health Care to Health: How Health Plans With Collaborators Are Re-Defining the Industry
Health Populi
FEBRUARY 4, 2024
Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. Patients and health plan members continue evolving into medical bill payers, with their homes and budgets baked into the concept.
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Seniors Satisfied With Medicare Supplemental Plan
BHM Healthcare Solutions
MARCH 5, 2019
Editor’s Note: Medicare Advantage organizations (MAOs) continue to do a poor job of maintaining accurate provider directories—and it’s landing some in hot water with the federal government. Seniors continue to be overwhelmingly satisfied with their Medicare supplemental insurance coverage.
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Patients-As-Health Care Payers Define What a Digital Front Door Looks Like
Health Populi
JUNE 6, 2023
pre-care cost estimates that are accurate (personalized based on their own health insurance plans), payment plans for paying medical bills over time, digital payment options (think: Venmo meets medical bills), a multi-purpose portal, and mobile access for both administrative tasks and care — that is, virtual care/telehealth.
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Value-Based Health Care Needs All Stakeholders at the Table – Especially the Patient
Health Populi
MARCH 11, 2021
health care, patient assistance programs, Medicare Advantage plans, and the bundling of proven high-value preventive services into the Affordable Care Act. In the case of Medicare Part D, the drug benefit, Chandra said, “If you’re sick enough to fall into the donut hole, you may have higher mortality.”
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Massachusetts governor signs law safeguarding telehealth coverage
Healthcare IT News - Telehealth
JANUARY 4, 2021
"I am proud to sign this legislation which promotes telehealth services that have become vital during this pandemic, expands access to high-quality, affordable care, takes steps to protect consumers from surprise medical bills, and preserves access to COVID-19 testing and treatment," said Baker in a statement. WHY IT MATTERS.
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Why health care costs are making consumers more afraid of medical bills than an actual illness
Henry Kotula
APRIL 24, 2018
Some 86 percent of those surveyed said they’re covered either through their employer, have insurance they purchased directly, or through government programs like Medicare and Medicaid. And 53 percent received a bill that was higher than they expected.
What Are The Current Regulatory Changes And Compliance Requirements That ASCs Need To Be Aware Of In Their Billing Practices?
Healthcare IT Today
JUNE 29, 2023
However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage.
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Will Consumers Cross the Cost-and-Trust Chasm Between Prescription Drugs and Hospitals?
Health Populi
OCTOBER 28, 2019
84% of Americans told the Foundation that they were concerned about how much health care costs will affect them in the future, with 42% of patients saying they couldn’t afford to pay over $500 for an unexpected medical bill. Hospital costs contribute to rising medical costs to 49% of health consumers.
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The Unbearable Heaviness of Inflation: Will Consumers’ Financial Stress Erode Their Health?
Health Populi
JUNE 23, 2022
An hour after the Morning Consult session, I brainstormed the topic of consumers-as-payers of medical bills and prescription drugs with GoodRx strategy leaders. billion savings that Medicare Part D could accrue if the program bought generic drugs at the prices offered through the Mark Cuban Cost Plus Drug Company.
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Health Care Bills’ Financial Toxicity – Remembering the Jones’ of Whatcom County, WA
Health Populi
AUGUST 11, 2019
“In an extreme example of angst over expensive medical bills , an elderly Washington couple who lived near the U.S.-Canadian Canadian border died in a murder-suicide this week after leaving notes that detailed concerns about paying for medical care,” USA Today reported on August 10, 2019. million all-in.
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While Costs Are A Top Concern Among Most U.S. Patients, So Are Challenges of Poverty, Food, and Housing
Health Populi
OCTOBER 28, 2019
In addition to paying for “my” medical bills, most people in the U.S. also say that income inequality and inadequate social services significantly contribute to high medical spending for every health citizen in the nation. This year’s poll was conducted in September 2019 and included input from 2,001 U.S.
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A Health Consumer Bill of Rights: Assuring Affordability, Access, Autonomy, and Equity
Health Populi
FEBRUARY 27, 2024
In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.
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The Latest KFF Poll on Consumer Experiences with Health Insurance Speaks Volumes About Patients’ Administrative Burden
Health Populi
JUNE 26, 2023
Note that one-third of people enrolled in Medicare or employer-sponsored insurance (ESI) self-rationed care due to cost in the past year. The top reason people in the U.S.
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Experian Health Acquires Wave HDC, Immediately Enabling Real-Time, Single Inquiry Insurance Discovery/Verification at the Point of Patient Registration
Healthcare IT Today
DECEMBER 22, 2023
Wave HDC offers several insurance “curators” including Coordination of Benefits, Eligibility, and Medicare Beneficiary Identifiers, and serves hospitals, laboratories, billing companies, and physician groups.
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Why Chronic Care Management is Essential for Healthcare Providers in 2024
DrKumo Remote Patient Monitoring
OCTOBER 16, 2024
The code can be billed monthly, as long as the chronic care management services meet the criteria outlined by Medicare. Complex CCM services, which typically require more time and resources, also have specific billing codes, allowing providers to receive reimbursement for more intensive care coordination efforts.
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The 2023 Health Economy – The Evolving Primary Care and Retail Health Convergence Through Trilliant Health’s Lens
Health Populi
SEPTEMBER 27, 2023
healthcare spending, with curves moving up and to the right, and the Medicare Hospital Insurance Trust Fund moving into the opposite direction toward insolvency by 2033. adults saying inflation has made it harder to pay medical bills.
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3 in 4 Insured Americans Worried About Medical Bills — Especially Women
Health Populi
DECEMBER 9, 2021
Both employees accessing employer-sponsored health care via the private sector and commercial insurance, as well as health citizens covered by public sector plans Medicare and Medicaid had concerns about medical bills. A little kindness goes a long way indeed.”
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Understanding the ICD-10 Code for Chronic Obstructive Pulmonary Disease
DrKumo Remote Patient Monitoring
JANUARY 26, 2023
Properly utilizing COPD codes can help healthcare providers (HCPs) with medical billing and coding, leading to accurate claim submission and reimbursement for their services. Therefore, it is important for HCPs to use these codes correctly when coding their medical services. Tobacco dependence (code: F17.2)
Wistful Thinking: The National Health Spending Forecast In a Land Without COVID-19
Health Populi
MARCH 26, 2020
” These factors come out of the 2019 Medicare Trustees Report and include but aren’t limited to tax policy, the state of insurance marketplaces, and employer-sponsored health insurance assumptions. Others of us who need to are having trouble accessing our health records.
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What Is CPT Code 99457
DrKumo Remote Patient Monitoring
APRIL 24, 2024
” In the dynamic landscape of modern healthcare, staying abreast of the latest developments in medical billing and coding is paramount for healthcare providers seeking to optimize patient care delivery and revenue generation. Welcome to our comprehensive guide to “What Is CPT Code 99457.”
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In U.S. Health Care, It’s Still the Prices, Stupid – But Transparency and Consumer Behavior Aren’t Working As Planned
Health Populi
JANUARY 18, 2019
On the positive side of transparency, the Centers for Medicare and Medicaid Services mandated that health care providers must post prices online, the requirement discussed here on CMS’s website. As the Harvard Chan-POLITICO study points out, prescription drug costs are top-of-mind for health consumers in America.
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166 Bonus Features – August 6, 2023 – 83% of hospitals are collecting SDoH data, 46% of hospitals planning to use large language models in the call center, and more
Healthcare IT Today
AUGUST 6, 2023
Partnerships Fintech company Cedar is working with Google Cloud to build AI-powered tools to hep patients understand medical bills. Chicago-based RUSH University System for Health chose Cadence for remote monitoring and virtual care for Medicare and Medicaid patients with chronic conditions.
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Turning Increased Ambulatory Volumes into Financial Strength: 4 Moves for RCM
Healthcare IT Today
OCTOBER 23, 2023
For example, as outpatient services such as infusions outpace projections , and as the Centers for Medicare & Medicaid Services open the door to more outpatient procedures by moving 11 procedures off its “inpatient only” list, ambulatory providers must have the financial strength to make the investments needed to support growth.
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Breaking the Cycle of Financial Toxicity
GlobalMed
OCTOBER 7, 2019
at least, we now expect that extensive medical treatment – whether that’s chemotherapy, ongoing dialysis visits or surgery to repair a broken femur – may involve significant medical bills. Hospital stays, outpatient visits, tests and medications can all add up, even when patients have health insurance. In the U.S.
Why People Are Still Avoiding the Doctor (It’s Not the Virus)
Henry Kotula
JUNE 21, 2020
While the survey didn’t ask people why they were putting off care, there is ample evidence that medical bills can be a powerful deterrent. “We A pharmacist helped, but Mr. Chapman no longer has insurance, and is not sure what he will do until he is eligible for Medicare later this year.
American healthcare: The good, bad, ugly, future
Henry Kotula
AUGUST 28, 2023
Americans today pay twice as much for the same medications as people in Europe largely because of Congressional legislation passed in 2003. Now, under provisions of the new Inflation Reduction Act , the government will be able to negotiate the prices of 10 widely prescribed medications based on how much Medicare’s Part D program spends.
MedEvolve’s Settlement: A Key Lesson in HIPAA Policy Involving HIPAA Business Associates
Telebehavioral Health Institute
JUNE 3, 2023
However, they are only covered entities if they transmit information electronically concerning a transaction for which HHS has adopted a standard, such as billing Health Plans. Insurance companies, HMOs, company health plans, and government programs like Medicare and Medicaid Health Care Clearinghouses.
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HIPAA Business Associates: Lessons Learned through MedEvolve’s Settlement
Telebehavioral Health Institute
JULY 11, 2023
However, they are only covered entities if they transmit information electronically concerning a transaction for which HHS has adopted a standard, such as billing Health Plans. Insurance companies, HMOs, company health plans, and government programs like Medicare and Medicaid Health Care Clearinghouses.
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40 HIPAA Business Associates: Lessons Learned through MedEvolve’s Settlement
Telebehavioral Health Institute
JUNE 3, 2023
However, they are only covered entities if they transmit information electronically concerning a transaction for which HHS has adopted a standard, such as billing Health Plans. Insurance companies, HMOs, company health plans, and government programs like Medicare and Medicaid Health Care Clearinghouses.
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Why Alexa’s bedside manner is bad for health care
Lloyd Price
JUNE 8, 2019
In April, at Fortune’s Brainstorm Health conference in San Diego, Bruce Broussard, CEO of health insurer Humana, said he believes technology will help patients receive help during medical crises, citing the benefits of home monitoring and the ability of doctors’ visits to be conducted by video conference.
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Healthcare IT Regulations – What Needs to Be Added and What Needs to Be Removed
Healthcare IT Today
SEPTEMBER 19, 2023
I would continue to advance CMS’ directive that by 2030 all Medicare and the bulk of Medicaid beneficiaries be in care engagements governed under a value-based contract.
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Getting Started with Telehealth
TheraNest
AUGUST 20, 2018
CCHPCA State Laws and Reimbursement Policies and their State Telehealth Laws and Reimbursement Policies PDF (April 2017) – This resource also you to stay up to date on all Telehealth laws, policies, regulations, and Medicare/Medicaid programs state by state. Understanding Telehealth Billing. Marketing Your Telehealth Service.
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#WWBR Week of September 22, 2014
Chilmark Research
SEPTEMBER 26, 2014
Medicare’s Pioneer program down to 19 ACOs after three more exit. After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know. And plenty of other great reading too. Enjoy the articles and have a great weekend! Melanie Davis for Modern Healthcare. ” – Brian.
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Weekender 5/18/18
HIStalk Weekender
MAY 18, 2018
As a cash-strapped buyer who just wants to know what I will be billed when my PCP orders a dermatology test for a sun spot that I’ve had for 10 years, what am to do? My first inclination is to at least publish the Medicare price. I absolutely hate when non-clinical people compare healthcare with any other industry.
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